Horizons 2017: Notes on Dr. Thomas Brown's ibogaine talk

Rough notes from Dr. Thomas Brown's's ibogaine talk at Horizons 2017:

• Iboga: a drug native to West Africa; religious sacrament in Cameroon and Gabon
• Opioid crisis now the leading cause of deaths for people under 50 in the US
  • Opioid mortality over time chart; 28-44 years of life lost per patient on average from opioid use
  • Standard treatment right now is opioid replacement therapy. Take treatment each day for years, if they stop using strong likelihood of relapse. Hard to retain people in treatment programs
• Howard Lotsof discovered ibogaine treatment for addiction serendipitously, June 1962. No heroin withdrawal after 30 hours of taking ibogaine
  • Animal studies in the 1990s showing efficacy. Also noribogaine and 18-MC (a "rationally designed drug"), possibly not psychoactive
• Brown and Alper 2017
  • Is ibogaine effective in opioid detox? (SOWS instrument)
  • Is treatment effective later on... (ASI instrument)
  • Effect size comparable to methadone for detox
  • Improvement in ASI relative to baseline at all follow-up points (by how much?)
• Qualitative accounts, personal experiences of treatment and life after treatment (not included in Brown and Alper 2017)
  • Sandi Hartman
    • First person Brown interviewed, in 2009
    • Sold her farm and drove cross-country to ibogaine clinic for her 60th birthday
    • Now Opioid-free
    • Went on to found her own treatment center, focusing on after-case for ibogaine treatment
  • Generalizations about patients' lives before treatment
    • Often suicidal
      • "If ibogaine doesn't work, I'm checking out"
    • Sense that opioids are killing them
      • "It was a slow suicide"
      • Giving up interests
    • Feeling numb, unmotivated, depressed
      • "You don't feel joy, you don't feel pain, you don't feel love, you don't feel at all"
      • "I had no motivation to do anything. Nothing was fun or interesting"
  • Generalizations about the ibogaine experience
    • Lengthy, physically, and emotionally difficult (ataxia, vomiting, regrets, reliving troubling experiences)
    • Alleviation of withdrawal experiences
    • Dream-like visions, panoramic viewpoint
    • Insights about the roots of one's addiction
    • Visions of an alternate present or a possible future
    • Mystical experiences – "Out of body experience... certainty of life after death"
    • Regrets; reconciliation and forgiveness
  • Generalizations about the post-treatment experience
    • Sense of renewal
    • Sense of purpose
      • People starting clinics after they are treated
      • Max had "Ibogaine" tattooed on his forearm
• Why not available in the US?
  • It's illegal & Schedule 1
  • Stigma about it being psychoactive; some scientists view this as a harmful side effect
  • Risks associated with ibogaine treatment (see below)
  • Little incentive for pharmaceutical companies to pursue ibogaine; it's naturally occurring (can't be patented) and only taken intermittently (not every day)
• Legislative efforts in VT and NY
  • Vermont "state of the state" speech 2014

• Lotsof and Wachtel 2003 – manual for ibogaine treatment

• Ibogaine death rate of 1 in 300 uses. Is that clinical or street?

  • Clinical, probably
  • But there are ibogaine centers that have administered thousands of treatments w/o having any poor outcomes
  • Brown doesn't see ibogaine as a last resort. Many people on methadone treatment want to get off it
• Longterm abstinence from ibogaine treatment?
  • Standard detox treatments have abysmal longterm followup rates
  • Brown's study is best evidence of longterm outcomes
  • No indication of adverse longterm effects
• What accounts for the withdrawal interruption caused by ibogaine?
  • Something pharmacological going on here
• Ibogaine distinct from other psychedelics for addiction in that it causes an immediate cessation of craving and withdrawal symptoms. Not understood what's going on here
  • Ken Alpert: ibogaine is not an opioid agonist; effective in animals, so presumably not entirely psychologically mediated
• Other applications?
  • Helpful for reducing depression, maybe. Shown in the New Zealand study but not in Brown and Alpert
  • Anecdotal evidence that it's helpful for Parkinsons, not studied yet

• What's being done re: legal advocacy for ibogaine?

  • Vermonters for Ibogaine Treatment, Molly Scott (?)
  • Activists in New York
  • Global Ibogaine Alliance

• No research into the efficacy of ritual coupled with ibogaine treatment (illegal in US)

  • Brown suspects there is an additive benefit to the ritual aspect
  • Clinics aren't incorporating any of the indigenous ritual understanding
• Ibogaine mostly for opioid addiction. Some people have tried it for alcoholism and smoking cessation. Anecdotal success there
  • Some evidence that ibogaine can reduce cravings for cocaine
  • The best treatment providers think it doesn't work for alcohol, doesn't work well for benzodiazepines